Engelrosenkilde1226

The use of GHB is still widespread with many hospitalised overdose cases.

A man in his fifties was found unconscious in the street and brought to our Acute Admissions. When first examined he was still unconscious, hypothermic, had snoring respiration and smelled of alcohol. He was otherwise haemodynamically stable. Blood samples showed elevated osmolal and anion gaps. The increase in the osmol gap could be explained by the ethanol level of 210mg/dL (46mmol/L), but the reason for the increased anion gap was unknown. selleck chemical and naloxone were administered without effect. As the ethanol concentration alone was unlikely to explain the clinical picture, extended toxicological tests were performed. GHB in plasma was very high (5.0mmol/L; 520mg/L) even though the sample was taken almost 4 hours after admission. The GHB concentration (present as an anion) corresponded to the increased anion gap. The patient was comatose for approximately 12 hours, which is unusually long in GHB poisoning.

Intoxication with GHB is important to consider in comatose patients where other causes are excluded. #link# Prolonged clinical course may be due to a saturation of the GHB metabolism after a large dose or ingestion of GBL or 1,4-butanediol, both of which are precursors to GHB.

Intoxication with GHB is important to consider in comatose patients where other causes are excluded. Prolonged clinical course may be due to a saturation of the GHB metabolism after a large dose or ingestion of GBL or 1,4-butanediol, both of which are precursors to GHB.

This article describes a scabies outbreak at a boarding school where failure of the first-line therapy was suspected.

A group of five students, two of whom were room-mates, presented with a varying degree of pruritic papular rash. Repeated treatments with permethrin monitored by the school nurse, in conjunction with a rigorous hygiene regimen, proved to be ineffective. Eventually all five students were prescribed a combination therapy consisting of permethrin and ivermectin. This treatment proved effective in all five students. Despite closely monitored treatment, monotherapy with permethrin failed in all five patients. We discuss whether the lack of response was due to failed application, inability to rid the home environment of mites, reinfection by unidentified infected individuals or increased tolerance to permethrin.

Repeated therapeutic failure when permethrin was used under controlled conditions and documented mechanisms for increased tolerance may indicate the last possibility. We therefore call for additional research on this topic.

Repeated therapeutic failure when permethrin was used under controlled conditions and documented mechanisms for increased tolerance may indicate the last possibility. We therefore call for additional research on this topic.

In 2008 the reimbursable prescription scheme was amended so that patients with severe, chronic pain could be prescribed opioids on reimbursable prescription. The purpose of this study was to investigate the prescribing of opioids on reimbursable prescription, the proportion of patients who started opioid treatment on reimbursable prescription who became long-term users, and the number of patients in 2018 who received higher dosages than the reimbursable prescription scheme permits.

Data were retrieved from the Norwegian Prescription Registry. Persons aged 18 or over who were dispensed at least one opioid on reimbursable prescription for severe, chronic pain in the period 2008-2018, were included.

The number of patients who were prescribed opioids on reimbursable prescription increased during the study period, and in 2018 the number was 17 383. Of these, 331 (1.9%) were prescribed more than 300mg oral morphine equivalents per day. After nine years, 48% of the patients who started with opioids in 2009 were still being prescribed opioids on reimbursable prescription.

A high proportion of patients with severe, chronic pain who started with opioids on reimbursable prescription became long-term users. A number of patients received higher dosages than are recommended.

A high proportion of patients with severe, chronic pain who started with opioids on reimbursable prescription became long-term users. A number of patients received higher dosages than are recommended.

Breast-conserving surgery is recommended in Norway and internationally in cases of early-stage breast cancer. We analysed the surgical methods used for breast-cancer patients by hospital providing treatment, age at the time of diagnosis, detection method and histopathological characteristics of the tumours in the period 2003 to 2018.

Data on women of all ages diagnosed with invasive breast cancer (n = 47 004) were retrieved from the Cancer Registry of Norway's databases. We excluded women with distant metastases at the time of diagnosis (n = 1 773) and those for whom no surgical method was recorded (n = 2 638). The detection method was defined as breast cancer detected by screening, in inter-screening intervals, or outside BreastScreen Norway. The surgical methods chosen were compared by means of descriptive analyses.

Slightly over half (23 661 of 42 593, i.e. 55.6%) of the women in whom breast cancer was detected in the study period underwent breast-conserving surgery. The percentage increased from 1 189/2 423 (49.1%) in 2003 to 2 070/2 958 (70.0%) in 2018. There were large differences across hospitals. In the period 2015-2018 we found the highest proportion of breast-conserving surgery, 175/187 (93.6%) for breast cancer detected by screening to be performed at Ålesund Hospital, and the lowest proportion, 121/351 (34.5%) among women with breast cancer detected outside BreastScreen Norway, to be performed at Radiumhospitalet. Breast-conserving surgery was used most frequently on women with small tumours without spreading to axillary lymph nodes.

We found considerable differences in the surgical methods used across hospitals and for different detection methods.

We found considerable differences in the surgical methods used across hospitals and for different detection methods.Submitral left ventricular aneurysm is a rare cardiac pathology with very few cases reported in the literature. These are nonischemic aneurysms mostly reported from Africa. Patients with submitral aneurysm exhibit varied clinical manifestations. We report a case of calcified submitral aneurysm and its successful surgical management through a transaneurysmal approach.